Healthcare Consumerism - Carnegie Mellon ece734/fall2014/lectures/7. Q1 Q2 Q3 Q4 Q1 Q2

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Transcript of Healthcare Consumerism - Carnegie Mellon ece734/fall2014/lectures/7. Q1 Q2 Q3 Q4 Q1 Q2

  • Healthcare Consumerism

    Converging Trends and Privacy Challenges

    Jing Wang MacKenzie, MD, MHA September 29, 2014

    Prepared for Carnegie Mellon University

  • US Healthcare is Ripe for Reform

    Predicted healthcare spending uncontained – Over $3 trillion for 2014 (almost equal to Germany’s entire GDP). – Around $4.5 trillion by 2020.

    People living with chronic disease increasing – Around 133 million in 2013. – Around 157 million by 2020 (around half the population). – Around 81 million will have multiple conditions. – Proportion of aging population (60 yrs and older), expected to increase from 11% (2009) to

    22% (2050), and would create additional demand for healthcare services

    Primary care provider shortage worsening – Nearly 52,000 additional primary care physicians needed by 2025, in comparison to 2010. – If the system for delivering primary care in 2020 were to remain fundamentally the same as

    today, there will be a projected shortage of 20,400 primary care physicians.

    1. Annual U.S. Healthcare Spending Hits $3.8 Trillion, Dan Munroe, Forbes.com, 2 Feb 2014. 2. The hidden costs of U.S. health care, Deloitte Center for Health Solutions, 2012. 3. About chronic diseases, National Health Council, 4 Nov 2013 4. World Population Ageing – Department of Economic and Social Affairs, United Nations. 5. Petterson SM, Liaw WR, Phillips RL, Rabin DL, Meyers DS, Bazemore AW. Projecting US Primary Care Physician Workforce Needs: 2010-2025. Annals of Family Medicine.

    2012; 10(6): 503-509

    Sources:

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  • The Asymmetry of Healthcare Spending versus Quality

    TOTAL MEDICARE REIMBURSEMENTS PER ENROLLEE, BY ADJUSTMENT TYPE (Adjustment Type: Price, Age, Sex & Race; Year: 2010; Region Level: HRR)

    CMS HOSPITAL COMPARE SUMMARY QUALITY SCORES, BY CONDITION (Condition: Overall; Year: 2007; Region Level: HRR)

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    Source: The Dartmouth Atlas of Healthcare

  • Disproportionate Cost Burden on Individuals

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  • Total Accountable Care Organizations by Sponsoring Entity

    Physician Group Hospital System Insurer Other

    Clear and Steady Trend toward Value-Based Care

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    Source: Leavitt Partners Center for Accountable Care Intelligence

    Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013

    300

    250

    200

    150

    100

    50

    0

    Estimated Accountable Care Lives

    20

    18

    16

    14

    12

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    # o

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    “Accountable Care Organizations are … Providers who are jointly held accountable for achieving the measured quality improvements and reductions in the rate of spending growth.”

    - Mark McClellan, MD, former Administrator for the Centers for Medicare and Medicaid Services

  • Consumer Segmentation by Healthcare Cost

    $40 – $100K

    5%

    6 – 20%

    21 – 50%

    50 – 100%

    50.6%

    23.7%

    22.6%

    3.1%

    $9 – $30K

    $2,583

    $248

    Segmentation based on healthcare spending

    Percentage of total expenditure

    Average expenditure per patient per year

    People with functional limitations and chronic conditions were over four times as likely to be in the top 5 percent of spenders as the general population.

    Source: http://aspe.hhs.gov/daltcp/reports/2010/closerlook.htm#top

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  • Targeted Care Model and Realty Gaps

    Facts:

    • Fifty percent of Americans don’t get the recommended preventive care and screening tests that science recommends.1

    • 60 percent of referrals go unscheduled2

    and 25% of scheduled appointments are missed.3

    • 42 percent PCPs report not having enough time with their patients.4

    Source: 1. Commonwealth Fund National Scorecard on U.S. Health

    System Performance, 2011 2. 2009 – 2011 Annals of Internal Medicine 3. http://ahec.health.ufl.edu/chs/2002/Noshows.pdf#sthash.

    OChH25JI.dpuf 4. http://www.dhcs.ca.gov/provgovpart/Documents/Bodenhe

    imerWebinar3.pdf Source: The Chronic Care Model by The MacColl Institute for Healthcare Innovation

    Informed, activated Patient

    Prepared, Proactive

    Practice Team

    Productive Interactions

    Community Resources and Policies

    Self-Management Support

    Health Systems

    Organization of Health Care

    Delivery System Design

    Decision Support

    Clinical Information System

    Improved Outcomes

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  • Higher Patient Activation Links to Better Care Outcome

    Source: Patient Activation and Engagement for ACOs, Judith H. Hibbard, PhD, adapted from AARP’s “Beyond 50.09” Patient Survey.

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  • Behaviors of Healthcare Consumers State a Paradox

    Source: 2012 Accenture Healthcare Consumer Survey

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    Most concerned about affordability

    72%

    30%

    81%

    Willing to change care setting or doctors to save costs

    Want help in improving their health and wellness

    40%

    Do not identify going to the doctor for regular checkups as a top priority

  • Lifestyle a Major Contributor to Health Status

    The estimate to the left is presented by Center for Disease Control as an estimate, while the precise numbers remain unknown.

    Source: http://www.cdc.gov/socialdeterminants/faq.html

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  • Patients Consumers

    Source: http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in- health-behaviours-is, with minor revision

    Patient to Consumer a Transformation Journey

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    http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is http://epatientselfmanagement.tumblr.com/post/40503081648/why-outcomes-data-for-changes-in-health-behaviours-is

  • On-line Consumer Segmentation by Market Value Most in Need = Least Digitally Invested

    Source: http://blogs.forrester.com/gina_fleming/14-07-11- the_data_digest_introducing_forresters_consumer_healthcare_segmentation

    Suffer from a serious or chronic condition; they are the segment most likely to be obese; and

    they are the oldest. They consume a lot of medical care: Not only

    have 92% visited a doctor’s office in the

    past year, but 37% have been to the ER.

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  • Consumerism – Bifurcated Definitions

    • Health consumerism is a movement which advocates patients’ involvement in their own health care decisions (Wikipedia).

    • Healthcare Consumerism is … about supplying the information and decision support tools (employees) need, along with financial incentives, rewards, and other benefits that encourage personal involvement in altering health and healthcare purchasing behaviors (The Institute for HealthCare Consumerism).

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